Women say there are too many barriers to access postpartum depression medication: Shot

Steve Insky, Host:

Postpartum depression affects one in eight new mothers in the United States. It’s a lot of moms. Two years ago, the FDA approved the first and only drug designed to treat it specifically. It’s called brexanolone, and most women who get it feel better within a few days. But the drug is expensive-$ 34,000. A new study from member station KQED also found that California’s largest insurer made it extremely difficult to obtain. Reporter April Denboski explains.

April Denboski, Byline: Miriam McDonald was 44 when he told his doctor he wanted another baby. The doctor said she was likely to win the lottery. So when she got pregnant, she and her husband were thrilled. But a few days after giving birth to my son, everything changed.

Miriam McDonald: Three days after giving birth to him, I was thinking of my god, oh. What did i do? I just brought this baby to this world and now I can hardly take care of myself. tired. I haven’t slept for 3 days. I haven’t really eaten for 3 days.

Denboski: Over the course of a few weeks, her depression got worse. She felt sad, but she was also indifferent.

McDonald’s: I didn’t want to hug my baby. I didn’t want to change him. I had nothing to do with my child.

Denboski: Miriam was worried that his mood could hurt his son’s development. She was worried that it wouldn’t work at all.

McDonald’s: I was crying every day. I thought about ending my life every day.

Denboski: Miriam went to Kaiser Permanente near Sacramento for help, and she says the doctor put her in a merry-go-round of drug trial and error. First, one drug …

McDonald’s: That made me more anxious than anything else.

Denboski: … then her doctor increased the dose of another drug.

McDonald’s: I had these horrific nightmares.

Denboski: So he tried another drug.

McDonald’s: That night I started to hallucinate. I actually heard a jazz band playing outside the window. It’s a full jazz band.

DEMBOSKY: She stopped taking it, but it took seven weeks for the effect to disappear completely. After that, her doctor retired. And when Miriam complained to her new doctor that she was still depressed for four months after giving birth, she suggested some more medicines.

McDonald’s: I was desperate. It was like trying to help myself, but things are getting worse. So what am I leaving? what do I do?

Denboski: Miriam did her own research and learned about a new drug called brexanolone. This is the first and only drug specially designed to treat postpartum depression. Unlike many antidepressants that target the serotonin system in the brain, brexanolone works by supplementing hormones that are depleted after childbirth. It is infused into the bloodstream for over 60 hours.

McDonald’s: As you know, you can go to the hospital for 3 days. They give you this medicine. It’s an injection. This really allowed me to get out of this postpartum depression.

Denboski: In clinical trials, 75% of women taking Brexanolone immediately began to feel better. Dr. Leah Patterson of UNC-Chapel Hill states that for most women who have been treated for the past two years, the results are day and night.

RIAH PATTERSON: People want to leave the hospital and go home because they want to be with their children. You can really see the changes in the hospital room over those 60 hours.

Denboski: But when Miriam asked for Brexanoron, her doctor said no. She said in an email that Miriam was not eligible under Kaiser’s standards. She said Miriam had to try and fail four doses and electroconvulsive therapy before trying Brexanolone. And all this had to happen within 6 months of having a baby. It was too late for Miriam. But she wondered how anyone could qualify.

McDonald’s: This is crazy. By the time you try one drug, it’s like four weeks. Another drug is 4 weeks. Another drug is 4 weeks. There is no way.

DEMBOSKY: Kaiser’s guidance is outliers. We analyzed a dozen health insurance guidelines. Three of them require women to fail one drug before trying Brexanolone. One plan requires two failures. However, Kaiser is the only system that recommends that women first fail the four medications and electroconvulsive therapy. Postpartum experts like Dr. Patterson at UNC say this is ridiculous.

Patterson: That’s ridiculous. And-so I don’t think women will have the opportunity to try Brexanolone.

DEMBOSKY: But Kaiser says these criteria are just recommendations, not requirements. Doctors do not have to follow them. Dr. Maria Cossy is the chair of Kaiser’s Northern California Psychiatry.

MARIA KOSHY: After all, this is an individual clinical decision by both the provider, the doctor, and the patient.

DEMBOSKY: But why issue clinical guidance when doctors don’t expect it to follow? Lawmakers and supporters say it doesn’t matter if the recommendation is mandatory. The effect is the same. And if they aren’t in line with scientific evidence and expert consensus, they may violate California’s new mental health equality law, and law advocates are a model for fixing loopholes in federal law. Say that. State Senator Scott Wiener is the author.

SCOTT WIENER: If Kaiser makes it virtually impossible to receive certain important mental health treatments, it could definitely violate our parity law.

DEMBOSKY: Kaiser officials replied that they always obey the law. The healthcare system operates in eight states and Washington, DC, and the guidelines for brexanolone are nationwide. Dr. Koshy admits that it was developed two years ago, based on the safety and efficacy data available at the time. She says Kaiser is currently considering the recommendations.

During that time, Miriam McDonald never got Brexanoron. However, she continued to fight for salvation and eventually had Kaiser cover another treatment called transcranial magnetic stimulation. Each session costs about $ 300. Miriam had to go five days a week for three months. Now she finally feels like her again.

McDonald’s: I remember. When I woke up one day, I was excited. And I was really pleased. Then he got up and entered his room. And I was like Nico, hey. Hello. Hey baby. Then he jumped out of the crib, laughed and put out his arms. And I held him in my arm and cried. I am very proud to be your mother.

Denboski: But it took me a year and a half to get there. Miriam says he hardly remembers his son taking the first step. She says she feels deprived of all those milestones that can never be returned.

For NPR News, I’m April Dembosky from Auckland.

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INSKEEP: This story comes from an NPR partnership with KQED and Kaiser Health News.

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